Pub Date : 2025-11-09DOI: 10.1016/j.healthpol.2025.105496
Andreea Corina Badache , Maja Dobrosavljevic , Sarah Louise Barber
Background
Population ageing has an impact on the need for long-term care (LTC) because functional limitations increase with age. Most older adults require support from family or formal LTC providers; thus, there is an urgent need for strategies to strengthen LTC workforce recruitment and retention.
Objective
To conduct an umbrella review to assess the strategies used to improve recruitment, retention, working conditions, and skills development of the formal LTC workforce.
Methods
Following the PRIOR guidelines and after protocol registration on PROSPERO, we conducted an umbrella review and searched four databases: MEDLINE, Embase, CINAHL, and Web of Science for intervention studies between 1946 and June 2024. Eligible studies were systematic reviews of interventions targeting formal LTC workers caring for adults aged 60 years and older. Two reviewers screened, extracted data, and appraised methodological quality.
Results
Of 10,475 screened articles, 19 reviews met the inclusion criteria. Continuing professional development and peer-led training consistently improved staff knowledge and competencies, and sometimes job satisfaction and turnover. The evidence for well-being programs and policies was limited and heterogeneous; overall, most reviews were of low quality.
Conclusions
Future research should improve the context and workforce roles, adopt standardized outcomes, and rigorously evaluate organizational and policy interventions.
背景：人口老龄化对长期护理（LTC）的需求有影响，因为功能限制随着年龄的增长而增加。大多数老年人需要家庭或正式的长期服务提供者的支持；因此，迫切需要制定战略来加强LTC劳动力的招聘和保留。目的：进行全面审查，以评估用于改善正式LTC劳动力的招聘，保留，工作条件和技能发展的策略。方法：遵循PRIOR指南并在PROSPERO方案注册后，我们进行了一项概览性综述，并检索了四个数据库：MEDLINE、Embase、CINAHL和Web of Science，以获取1946年至2024年6月期间的干预研究。符合条件的研究是针对照顾60岁及以上成年人的正式LTC工作人员的干预措施的系统评价。两名审稿人筛选、提取数据并评估方法学质量。结果：10475篇筛选文章中，19篇综述符合纳入标准。持续的专业发展和同行领导的培训不断提高员工的知识和能力，有时工作满意度和流动率。福利计划和政策的证据有限且不一致；总的来说，大多数评论的质量都很低。结论：未来的研究应改善情境和劳动力角色，采用标准化结果，并严格评估组织和政策干预措施。
{"title":"Strategies to improve recruitment, retention, working conditions, and skills among the long-term care workforce: An umbrella review of existing evidence","authors":"Andreea Corina Badache , Maja Dobrosavljevic , Sarah Louise Barber","doi":"10.1016/j.healthpol.2025.105496","DOIUrl":"10.1016/j.healthpol.2025.105496","url":null,"abstract":"<div><h3>Background</h3><div>Population ageing has an impact on the need for long-term care (LTC) because functional limitations increase with age. Most older adults require support from family or formal LTC providers; thus, there is an urgent need for strategies to strengthen LTC workforce recruitment and retention.</div></div><div><h3>Objective</h3><div>To conduct an umbrella review to assess the strategies used to improve recruitment, retention, working conditions, and skills development of the formal LTC workforce.</div></div><div><h3>Methods</h3><div>Following the PRIOR guidelines and after protocol registration on PROSPERO, we conducted an umbrella review and searched four databases: MEDLINE, Embase, CINAHL, and Web of Science for intervention studies between 1946 and June 2024. Eligible studies were systematic reviews of interventions targeting formal LTC workers caring for adults aged 60 years and older. Two reviewers screened, extracted data, and appraised methodological quality.</div></div><div><h3>Results</h3><div>Of 10,475 screened articles, 19 reviews met the inclusion criteria. Continuing professional development and peer-led training consistently improved staff knowledge and competencies, and sometimes job satisfaction and turnover. The evidence for well-being programs and policies was limited and heterogeneous; overall, most reviews were of low quality.</div></div><div><h3>Conclusions</h3><div>Future research should improve the context and workforce roles, adopt standardized outcomes, and rigorously evaluate organizational and policy interventions.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105496"},"PeriodicalIF":3.4,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health and care workforces across Europe face overlapping crises that test their resilience and governance capacities. In the Czech Republic, the COVID-19 pandemic was swiftly followed by a major influx of Ukrainian refugees, creating new pressures on both frontline healthcare workers and intercultural care workers.
Objective
To explore, from the perspectives of frontline healthcare workers and intercultural care workers, how governance capacities and gaps shaped workforce functioning, adaptation, and resilience during the refugee response in the CR, and what lessons this experience offers for strengthening workforce governance in times of multiple crises.
Methods
Thirty semi-structured interviews with frontline healthcare workers and three focus groups with 20 intercultural care workers (September 2022–June 2023) were analysed thematically within a multi-level governance framework.
Results
Fragmented coordination, lack of intercultural training, and limited psychosocial and managerial support undermined resilience. Intercultural care workers played critical but unrecognised roles bridging linguistic and cultural gaps, while refugee health workers remained underused due to rigid qualification rules and limited pathways for integration. Despite strong moral commitment and informal collaboration, reliance on individual initiative rather than structured governance weakened equity and preparedness.
Conclusions
Preparedness depends on governance that sustains the human and cultural dimensions of care. Strengthening coordination across levels, formally recognising intercultural roles within health organisations, and enabling refugee health worker integration through flexible qualification procedures are timely and achievable governance priorities for building resilient and inclusive health workforces across Europe.
{"title":"Health and care workforce preparedness in response to the influx of Ukrainian refugees: a qualitative study from the Czech Republic","authors":"Zuzana Kotherová , Karolína Dobiášová , Jolana Kopsa Těšinová , Elena Tulupova","doi":"10.1016/j.healthpol.2025.105495","DOIUrl":"10.1016/j.healthpol.2025.105495","url":null,"abstract":"<div><h3>Background</h3><div>Health and care workforces across Europe face overlapping crises that test their resilience and governance capacities. In the Czech Republic, the COVID-19 pandemic was swiftly followed by a major influx of Ukrainian refugees, creating new pressures on both frontline healthcare workers and intercultural care workers.</div></div><div><h3>Objective</h3><div>To explore, from the perspectives of frontline healthcare workers and intercultural care workers, how governance capacities and gaps shaped workforce functioning, adaptation, and resilience during the refugee response in the CR, and what lessons this experience offers for strengthening workforce governance in times of multiple crises.</div></div><div><h3>Methods</h3><div>Thirty semi-structured interviews with frontline healthcare workers and three focus groups with 20 intercultural care workers (September 2022–June 2023) were analysed thematically within a multi-level governance framework.</div></div><div><h3>Results</h3><div>Fragmented coordination, lack of intercultural training, and limited psychosocial and managerial support undermined resilience. Intercultural care workers played critical but unrecognised roles bridging linguistic and cultural gaps, while refugee health workers remained underused due to rigid qualification rules and limited pathways for integration<strong>.</strong> Despite strong moral commitment and informal collaboration, reliance on individual initiative rather than structured governance weakened equity and preparedness.</div></div><div><h3>Conclusions</h3><div>Preparedness depends on governance that sustains the human and cultural dimensions of care. Strengthening coordination across levels, formally recognising intercultural roles within health organisations, and enabling refugee health worker integration through flexible qualification procedures are timely and achievable governance priorities for building resilient and inclusive health workforces across Europe.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105495"},"PeriodicalIF":3.4,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Comprehensive and standardized health workforce data are the foundation of more robust planning and evidence-informed decision-making in the face of multiple crises.
Objective
This paper describes the process, results, and lessons learned in co-developing an inclusive, interprofessional health workforce minimum data standard (MDS) for planning.
Methods
A four-phase development process was undertaken: 1) we gathered existing data standards through an environmental scan and literature review, from which we synthesized common data elements into modules; 2) we gathered input through collaborator engagement on the suitability of these data elements to address their priority planning questions; 3) we reviewed the retained data elements with information garnered from an ongoing integrated primary care health workforce planning process; 4) collaborating partners provided detailed feedback on the drafted MDS data elements.
Results
Data elements, their sources and other metadata identified from the scans were synthesized into three modules on health worker capacity, education, and identification. Consultation feedback led to refinements and additional data elements. The retrospective review led to a streamlining of the number elements within each module. Partner feedback led to further refinement, mindful of implementation, including dividing them into a core and supplemental set.
Conclusions
Co-developing an MDS for planning benefits from building off existing data standards, open and ongoing collaborator engagement for buy-in, and practical considerations balancing adding more data against finding the right data elements to fit planning needs. Although the MDS was developed for a Canadian context, the approach and outputs are transferable to other settings.
{"title":"Co-developing an inclusive interprofessional health workforce minimum data standard for enhanced planning and decision-making: A Canadian case with international relevance","authors":"Katherine Zagrodney , Dax Bourcier , Neeru Gupta , Sarah Simkin , Rachelle Ashcroft , Brenna Bath , Houssem Eddine Ben-Ahmed , Natalie Crown , Brenda Gamble , Kathleen Leslie , Angela Mashford-Pringle , Sophia Myles , Danielle Rice , Arthur Sweetman , Ivy Lynn Bourgeault","doi":"10.1016/j.healthpol.2025.105485","DOIUrl":"10.1016/j.healthpol.2025.105485","url":null,"abstract":"<div><h3>Background</h3><div>Comprehensive and standardized health workforce data are the foundation of more robust planning and evidence-informed decision-making in the face of multiple crises.</div></div><div><h3>Objective</h3><div>This paper describes the process, results, and lessons learned in co-developing an inclusive, interprofessional health workforce minimum data standard (MDS) for planning.</div></div><div><h3>Methods</h3><div>A four-phase development process was undertaken: 1) we gathered existing data standards through an environmental scan and literature review, from which we synthesized common data elements into modules; 2) we gathered input through collaborator engagement on the suitability of these data elements to address their priority planning questions; 3) we reviewed the retained data elements with information garnered from an ongoing integrated primary care health workforce planning process; 4) collaborating partners provided detailed feedback on the drafted MDS data elements.</div></div><div><h3>Results</h3><div>Data elements, their sources and other metadata identified from the scans were synthesized into three modules on health worker capacity, education, and identification. Consultation feedback led to refinements and additional data elements. The retrospective review led to a streamlining of the number elements within each module. Partner feedback led to further refinement, mindful of implementation, including dividing them into a core and supplemental set.</div></div><div><h3>Conclusions</h3><div>Co-developing an MDS for planning benefits from building off existing data standards, open and ongoing collaborator engagement for buy-in, and practical considerations balancing adding more data against finding the right data elements to fit planning needs. Although the MDS was developed for a Canadian context, the approach and outputs are transferable to other settings.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105485"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cash transfer programs are widely used to support household income and improve socioeconomic well-being. We examine the health impact of a nationwide transfer introduced in Italy in 2015, targeted at middle-income groups and providing up to €960 annually per beneficiary.
Objective
To assess the effect of the program on municipal all-cause mortality.
Methods
Leveraging panel data for all municipalities from 2010 to 2019, we exploit variation in treatment intensity induced by eligibility rules. Intensity is measured via per capita disbursements and share of beneficiaries. We estimate fixed-effects regressions with socio-demographic and economic covariates, regional time trends, and controls for spatial dependence.
Results
Increased transfer intensity is significantly associated with lower mortality: an additional €1 per capita corresponds to 0.004 fewer deaths per 1000 residents, while a one-percentage-point increase in the beneficiary share corresponds to a 0.03 decrease in the same outcome. Heterogeneity analyses suggest stronger effects in municipalities with higher education levels and better healthcare access, indicating that these factors enhance the translation of income support into health gains.
Conclusions
Although not designed with health objectives, broad-based income support programs can yield measurable improvements in population health, particularly when complemented by education and healthcare investments.
{"title":"Cash transfers and health outcomes: Evidence from Italian municipalities","authors":"Stefania Fontana , Calogero Guccio , Giacomo Pignataro , Domenica Romeo","doi":"10.1016/j.healthpol.2025.105494","DOIUrl":"10.1016/j.healthpol.2025.105494","url":null,"abstract":"<div><h3>Background</h3><div>Cash transfer programs are widely used to support household income and improve socioeconomic well-being. We examine the health impact of a nationwide transfer introduced in Italy in 2015, targeted at middle-income groups and providing up to €960 annually per beneficiary.</div></div><div><h3>Objective</h3><div>To assess the effect of the program on municipal all-cause mortality.</div></div><div><h3>Methods</h3><div>Leveraging panel data for all municipalities from 2010 to 2019, we exploit variation in treatment intensity induced by eligibility rules. Intensity is measured via per capita disbursements and share of beneficiaries. We estimate fixed-effects regressions with socio-demographic and economic covariates, regional time trends, and controls for spatial dependence.</div></div><div><h3>Results</h3><div>Increased transfer intensity is significantly associated with lower mortality: an additional €1 per capita corresponds to 0.004 fewer deaths per 1000 residents, while a one-percentage-point increase in the beneficiary share corresponds to a 0.03 decrease in the same outcome. Heterogeneity analyses suggest stronger effects in municipalities with higher education levels and better healthcare access, indicating that these factors enhance the translation of income support into health gains.</div></div><div><h3>Conclusions</h3><div>Although not designed with health objectives, broad-based income support programs can yield measurable improvements in population health, particularly when complemented by education and healthcare investments.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105494"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-06DOI: 10.1016/j.healthpol.2025.105470
Katarzyna Kolasa , Katarzyna Baliga-Nicholson , Jaroslaw Wasniewski , Krystyna Milian , Dominika Ciupek
{"title":"Corrigendum to “Shall we call for a doctor? How to build trust toward AI in healthcare: Insights from a Polish cross-sectional preference study” [Health policy 159 (2025) 105379]","authors":"Katarzyna Kolasa , Katarzyna Baliga-Nicholson , Jaroslaw Wasniewski , Krystyna Milian , Dominika Ciupek","doi":"10.1016/j.healthpol.2025.105470","DOIUrl":"10.1016/j.healthpol.2025.105470","url":null,"abstract":"","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105470"},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.healthpol.2025.105486
Maria Pinelli , Marcia Tummers , Janneke Grutters
Background
Rapid advancements in technology affect the quality and sustainability of the healthcare system. Decisions regarding technology procurement and adoption are made by different actors at various levels within hospitals.
Objective
The aim of this study was to understand hospitals’ strategies, scanning and assessment processes towards technology in hospitals and identify inherent trends and challenges connected to them.
Methods
Semi-structured interviews were performed covering hospitals’ strategies, scanning and assessment processes, examined through thematic analysis. Interviewees were members of board of directors, medical doctors, medical physicists, chief (medical) information officers and innovation managers, working in 7 different hospitals in the Netherlands.
Results
The number of respondents was 24: 6 Chief Executive Officers or Board of Directors members, 6 Medical Doctors, 4 Chief Information/Medical Information Officers, 4 Innovation Managers, and 4 Medical Physicists. Thematic analysis revealed hospitals prioritize optimal patient care, with academic hospitals emphasizing their additional role in research and education. They focus on specific clinical areas in order to excel. Some aim to pioneer new technologies. Typically, the implementation of new technologies is initiated by professionals and approved by management. Hospitals' scanning and assessment of emerging technologies, and assessment of implemented technologies, lacks a systematic approach, with some interviewees preferring better standardization. Other interviewees advocated for experimentation with innovative technology without evaluation constraints.
Conclusions
This paper shows there is not a standard strategy, scanning and assessment of health technologies within hospitals. More systematic technology scanning and assessment processes could potentially benefit hospitals, facilitating streamlined decision-making and efficient use of resources.
{"title":"How do strategy, scanning, and assessment shape decision-making on technologies in hospitals? insights from a qualitative study in Dutch hospitals","authors":"Maria Pinelli , Marcia Tummers , Janneke Grutters","doi":"10.1016/j.healthpol.2025.105486","DOIUrl":"10.1016/j.healthpol.2025.105486","url":null,"abstract":"<div><h3>Background</h3><div>Rapid advancements in technology affect the quality and sustainability of the healthcare system. Decisions regarding technology procurement and adoption are made by different actors at various levels within hospitals.</div></div><div><h3>Objective</h3><div>The aim of this study was to understand hospitals’ strategies, scanning and assessment processes towards technology in hospitals and identify inherent trends and challenges connected to them.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were performed covering hospitals’ strategies, scanning and assessment processes, examined through thematic analysis. Interviewees were members of board of directors, medical doctors, medical physicists, chief (medical) information officers and innovation managers, working in 7 different hospitals in the Netherlands.</div></div><div><h3>Results</h3><div>The number of respondents was 24: 6 Chief Executive Officers or Board of Directors members, 6 Medical Doctors, 4 Chief Information/Medical Information Officers, 4 Innovation Managers, and 4 Medical Physicists. Thematic analysis revealed hospitals prioritize optimal patient care, with academic hospitals emphasizing their additional role in research and education. They focus on specific clinical areas in order to excel. Some aim to pioneer new technologies. Typically, the implementation of new technologies is initiated by professionals and approved by management. Hospitals' scanning and assessment of emerging technologies, and assessment of implemented technologies, lacks a systematic approach, with some interviewees preferring better standardization. Other interviewees advocated for experimentation with innovative technology without evaluation constraints.</div></div><div><h3>Conclusions</h3><div>This paper shows there is not a standard strategy, scanning and assessment of health technologies within hospitals. More systematic technology scanning and assessment processes could potentially benefit hospitals, facilitating streamlined decision-making and efficient use of resources.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105486"},"PeriodicalIF":3.4,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.healthpol.2025.105493
Line Bjørnskov Pedersen , Maria Bundgaard , Eskild Klausen Fredslund , Jens Søndergaard , Marius Brostrøm Kousgaard , Sonja Wehberg , Dorte Ejg Jarbøl
Globally, a more rational use of antibiotics is needed to face the threat of antimicrobial resistance. In 2018, quality clusters were introduced in Danish general practice as a new quality improvement initiative. In the clusters, general practitioners engage in self-selected quality improvement topics, such as antibiotics prescribing. This study investigates whether engaging with antibiotics as a topic in quality clusters improves antibiotics prescribing, and whether choice and number of quality improvement strategies matter for behaviour change. We link register data on redeemed antibiotics prescriptions from Danish general practice from 2015–2020 with survey data from 2020 on whether, when, and how practices in clusters engaged with antibiotics as a quality improvement topic. We use a difference-in-differences approach including general practice fixed effects and practice-averaged time-varying patient population characteristics in linear regressions models. We find that practices engaged with antibiotics as a quality improvement topic increase their proportion of narrow spectrum antibiotics prescriptions compared to other practices, while there is no difference in changes in the total number of prescribed antibiotics. Neither the choice nor the number of surveyed quality improvement strategies seem to influence the behavioural outcomes. In conclusion, engaging in antibiotics in quality clusters to some extent improved antibiotic prescribing.
{"title":"Impact of quality clusters on antibiotic prescribing patterns. A difference-in-differences study from Danish general practice","authors":"Line Bjørnskov Pedersen , Maria Bundgaard , Eskild Klausen Fredslund , Jens Søndergaard , Marius Brostrøm Kousgaard , Sonja Wehberg , Dorte Ejg Jarbøl","doi":"10.1016/j.healthpol.2025.105493","DOIUrl":"10.1016/j.healthpol.2025.105493","url":null,"abstract":"<div><div>Globally, a more rational use of antibiotics is needed to face the threat of antimicrobial resistance. In 2018, quality clusters were introduced in Danish general practice as a new quality improvement initiative. In the clusters, general practitioners engage in self-selected quality improvement topics, such as antibiotics prescribing. This study investigates whether engaging with antibiotics as a topic in quality clusters improves antibiotics prescribing, and whether choice and number of quality improvement strategies matter for behaviour change. We link register data on redeemed antibiotics prescriptions from Danish general practice from 2015–2020 with survey data from 2020 on whether, when, and how practices in clusters engaged with antibiotics as a quality improvement topic. We use a difference-in-differences approach including general practice fixed effects and practice-averaged time-varying patient population characteristics in linear regressions models. We find that practices engaged with antibiotics as a quality improvement topic increase their proportion of narrow spectrum antibiotics prescriptions compared to other practices, while there is no difference in changes in the total number of prescribed antibiotics. Neither the choice nor the number of surveyed quality improvement strategies seem to influence the behavioural outcomes. In conclusion, engaging in antibiotics in quality clusters to some extent improved antibiotic prescribing.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105493"},"PeriodicalIF":3.4,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.healthpol.2025.105484
Martijn Felder , Roland Bal , Eline Ree , Maren Sogstad , Sharon Stoddart , Louise A. Ellis , Florin Tibu , Federico Vola , Paola Cantarelli , Juana María Delgado-Saborit , Estefania Aparicio , Mari Lahti , Eila Kankaanpää , Siri Wiig , Iris Wallenburg , Hilda Bø Lyng
Background
Welfare states face multiple challenges in the sustainable organization of their long-term care (LTC) systems due to aging populations and structural workforce shortages. In this context, the need emerges to facilitate cross-country exchange of policy responses to strengthen LTC resilience.
Objectives
In this paper, we provide comparative insight into the LTC systems of Norway, Finland, the Netherlands, Romania, Spain, Italy, and Australia. We identify key challenges in organizing LTC in these systems and compare strategies implemented to enhance LTC resilience.
Methods
Our qualitative cross-country analysis is based on the Consolidated Framework for Implementation Research and adapted for LTC contexts. Data was derived from OECD databases and complemented with country specific publicly available data sources.
Results
We show that participating countries face similar workforce challenges and adopt comparable strategies such as aging-in-place policies, technological innovation, service integration, and task shifting. Subtle yet crucial differences can however be observed in the broader systemic conditions in place to support LTC employment, and in the trade-offs being made between care quality and accessibility. The differences highlight the crucial role of LTC organizations and particularly middle managers in translating workforce strategies into situated interventions that strengthen both organizational resilience and individual well-being.
Conclusions
To enhance LTC resilience in both the short and long term, translational challenges include strengthening the connections to informal carers; stabilizing ehealth technologies to support ageing-in-place; and balancing individual workers’ ambitions and needs with organizational goals to keep healthcare accessible, responsive and of good quality.
{"title":"Different systems, same challenges: a comparative analysis of long-term care resilience in Norway, Finland, the Netherlands, Romania, Spain, Italy and Australia","authors":"Martijn Felder , Roland Bal , Eline Ree , Maren Sogstad , Sharon Stoddart , Louise A. Ellis , Florin Tibu , Federico Vola , Paola Cantarelli , Juana María Delgado-Saborit , Estefania Aparicio , Mari Lahti , Eila Kankaanpää , Siri Wiig , Iris Wallenburg , Hilda Bø Lyng","doi":"10.1016/j.healthpol.2025.105484","DOIUrl":"10.1016/j.healthpol.2025.105484","url":null,"abstract":"<div><h3>Background</h3><div>Welfare states face multiple challenges in the sustainable organization of their long-term care (LTC) systems due to aging populations and structural workforce shortages. In this context, the need emerges to facilitate cross-country exchange of policy responses to strengthen LTC resilience.</div></div><div><h3>Objectives</h3><div>In this paper, we provide comparative insight into the LTC systems of Norway, Finland, the Netherlands, Romania, Spain, Italy, and Australia. We identify key challenges in organizing LTC in these systems and compare strategies implemented to enhance LTC resilience.</div></div><div><h3>Methods</h3><div>Our qualitative cross-country analysis is based on the Consolidated Framework for Implementation Research and adapted for LTC contexts. Data was derived from OECD databases and complemented with country specific publicly available data sources.</div></div><div><h3>Results</h3><div>We show that participating countries face similar workforce challenges and adopt comparable strategies such as aging-in-place policies, technological innovation, service integration, and task shifting. Subtle yet crucial differences can however be observed in the broader systemic conditions in place to support LTC employment, and in the trade-offs being made between care quality and accessibility. The differences highlight the crucial role of LTC organizations and particularly middle managers in translating workforce strategies into situated interventions that strengthen both organizational resilience and individual well-being.</div></div><div><h3>Conclusions</h3><div>To enhance LTC resilience in both the short and long term, translational challenges include strengthening the connections to informal carers; stabilizing ehealth technologies to support ageing-in-place; and balancing individual workers’ ambitions and needs with organizational goals to keep healthcare accessible, responsive and of good quality.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"163 ","pages":"Article 105484"},"PeriodicalIF":3.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-08-06DOI: 10.1016/j.healthpol.2025.105390
Paolo Berta, Gilberto Turati
<p><strong>Research in context: </strong>(1) What is already known about the topic? Low birth weight (LBW) is a key marker of early-life health disadvantage, associated with increased mortality, delayed development, and long-term socioeconomic challenges. Health disparities related to LBW are predictive of future health outcomes and life trajectories. Although universal healthcare systems can mitigate such inequalities, their effectiveness varies across health domains and population subgroups. (2) What does this study add to the literature? This study examines how LBW-related health disparities evolve during early childhood within the universal healthcare system of Lombardy, Italy. Using robust statistical approaches, including twin fixed-effect models, the study shows that initial disadvantages in hospitalization rates and severity substantially decrease within the first 1000 days of life, particularly for nervous and digestive system conditions. However, disparities persist in respiratory diseases, indicating uneven mitigation across health domains. The study contributes new evidence on how universal healthcare can promote health equity in early life, while highlighting residual areas of concern. (3) What are the policy implications? The findings suggest that universal healthcare systems can significantly reduce health inequalities linked to LBW, but targeted interventions are necessary to address persistent disparities-especially in respiratory health. Policymakers should consider strengthening prenatal and neonatal care and designing condition-specific strategies that extend beyond infancy. Tailored support for LBW infants can further improve long-term outcomes and enhance the overall effectiveness of universal healthcare in promoting equitable health.</p><p><strong>Background: </strong>Early-life health inequalities can shape long-term health outcomes. This study examines disparities in hospitalization rates and severity between low- and normal-birth-weight children aged 0-3 years in Lombardy, Italy, under a universal public healthcare system.</p><p><strong>Objective: </strong>To analyze the evolution of early-life health inequalities in hospitalization rates and severity between low- and normal-birth-weight children.</p><p><strong>Methods: </strong>A retrospective longitudinal study leveraging a unique administrative dataset that integrates birth records and hospital discharge data for a large cohort of children in Lombardy. This approach allows for a robust analysis of hospitalization probabilities, total reimbursement costs, and hospital length of stay over the critical first 1000 days of life. Subgroup analyses focus on nervous, digestive, and respiratory diseases. Twin birth data are used to strengthen causal inference.</p><p><strong>Results: </strong>Low-birth-weight children experience higher hospitalization rates and greater severity in the first year of life, but disparities substantially decline over time, with no significant diffe
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Pub Date : 2025-11-01Epub Date: 2025-08-05DOI: 10.1016/j.healthpol.2025.105410
Michael Guo, Nicolas Mourad, Ahmer Karimuddin, Jason M Sutherland
Background: Canada's growing immigrant population faces language and cultural barriers that hinder timely access to healthcare. The balance between elective and emergency general surgery (EGS) reflects immigrant's access to healthcare since many EGS cases are avoidable through treatment as elective procedures.
Objective: This study examines whether immigrants are more likely to undergo EGS than non-immigrants and measures whether language proficiency or access to primary care plays a role in disparity in access to care.
Methods: All general surgery procedures performed in British Columbia, Canada between 2013 and 2021 were identified using a population-based longitudinal administrative data that linked immigration data with physician billing and hospital data. The primary outcome was whether patients' surgery was elective or EGS and the primary exposure was immigrant status. The odds of EGS between immigrants and non-immigrants was estimated adjusting for patient and system-level differences. The analysis compared immigrants with and without English proficiency on arrival to Canada.
Results: Of 237,054 general surgery procedures, 30.7 % were EGS and 15.2 % involved immigrants. Immigrants had slightly higher odds of undergoing emergency general surgery (EGS) than non-immigrants. Immigrants not fluent in English had 16 % higher odds of EGS (OR: 1.16, 95 %CI 1.03-1.32). Immigrants with fewer GP contacts were more likely to undergo EGS (45.5 % versus 42.2 %, p < 0.01).
Conclusions: Immigrants with language barriers and who accessed primary care less often were more likely to require EGS. These findings highlight the need for system-level interventions to reduce immigrants' reliance on emergency surgical care.
背景：加拿大不断增长的移民人口面临语言和文化障碍，阻碍了及时获得医疗保健。选择性和紧急普通外科手术（EGS）之间的平衡反映了移民获得医疗保健的机会，因为许多EGS病例可以通过选择性手术治疗来避免。目的：本研究考察移民是否比非移民更有可能经历EGS，并测量语言能力或获得初级保健是否在获得保健的差异中起作用。方法：使用基于人口的纵向管理数据，将移民数据与医生账单和医院数据联系起来，确定2013年至2021年在加拿大不列颠哥伦比亚省进行的所有普通外科手术。主要结果是患者的手术是选择性的还是EGS，主要暴露是移民身份。移民和非移民之间EGS的几率是根据患者和系统水平的差异进行估计的。该分析比较了抵达加拿大时英语水平和英语水平不高的移民。结果：在237,054例普通外科手术中，30.7%为EGS， 15.2%涉及移民。移民接受紧急普通外科手术（EGS）的几率略高于非移民。英语不流利的移民患EGS的几率高出16% （OR: 1.16, 95% CI 1.03-1.32）。接触全科医生较少的移民更有可能接受EGS（45.5%比42.2%,p < 0.01）。结论：有语言障碍和获得初级保健较少的移民更有可能需要EGS。这些发现强调了系统层面干预的必要性，以减少移民对紧急外科护理的依赖。
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